Hardik Madia Application form

1. LA MARTINIERE FOR BOYS' KOLKATA
Application For Admission To Class - VIII, 2010-2011
(PLEASE COMPLETE THIS FORM IN CAPITAL LETTERS USING BLACK INK)
PERSONAL DATA OF THE STUDENT
NAME
(as given in the Municipal HARDIK MADIA
Corporation birth certificate)
DATE OF BIRTH 10TH JUNE 1997
NATIONALITY INDIAN
RELIGION
(If Christian please mention JAINISM
Roman/Catholic/CNI etc.)
COMMUNITY GUJARATI
MOTHER TONGUE GUJARATI
SEVENTH DAY ADVENTIST SR.
CURRENT SCHOOL
SECONDARY SCHOOL
63D, CHAKRABERIA ROAD
RESIDENTIAL ADDRESS AND PHONE (NORTH), LANSDOWNE
NO.(S) CHAKRABERIA CROSSING KOLKATA-
20
DETAILS OF PARENTS
FATHER'S NAME VIPUL MADIA
MOTHER'S NAME ASHA MADIA
FATHER'S SCHOOL C.A.G. SCHOOL
MOTHER'S SCHOOL CARMEL HIGH SCHOOL
DETAILS OF OTHER CHILDREN
NAME PURAV MADIA
CLASS X
AGE 15
SEVENTH DAY ADVENTIST SR.
SCHOOL
SECONDARY SCHOOL